Pulst-Korenberg Alexandra, Morris Stephen C
Commonwealth Health Care, Saipan (Northern Mariana Islands), USA.
Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
Case Rep Emerg Med. 2020 Feb 13;2020:4963493. doi: 10.1155/2020/4963493. eCollection 2020.
Descending necrotizing mediastinitis and pharyngeal perforation are uncommon complications of pharyngitis that are associated with high morbidity and mortality. This case report describes a previously healthy 18-year-old male who presented to the emergency room with 5 days of severe sore throat, intermittent fevers, and vomiting and was found to have extensive posterior pharyngeal and mediastinal air along with extravasation of contrast on computed tomography, consistent with perforation of the left aryepiglottic fold as well as descending necrotizing mediastinitis. The patient had a complicated hospital course including multiple operative interventions, abscess formation, and development of pericardial and pleural effusions. Successful treatment required swift resuscitation including broad-spectrum antibiotics and significant coordination of emergent operative intervention between otolaryngology and cardiothoracic surgery. It is important to recognize descending necrotizing mediastinitis as a clinical entity that may result from oropharyngeal infections as early intervention significantly decreases subsequent complications and mortality. Furthermore, pharyngeal perforation is an extremely rare complication which requires either CT with oral contrast or esophagram for diagnosis.
下行性坏死性纵隔炎和咽穿孔是咽炎罕见的并发症，与高发病率和死亡率相关。本病例报告描述了一名既往健康的18岁男性，因严重咽痛、间歇性发热和呕吐5天就诊于急诊室，计算机断层扫描显示咽后部和纵隔广泛积气以及造影剂外渗，符合左杓会厌襞穿孔及下行性坏死性纵隔炎。患者住院过程复杂，包括多次手术干预、脓肿形成以及心包和胸腔积液的发生。成功的治疗需要迅速复苏，包括使用广谱抗生素以及耳鼻喉科和心胸外科之间紧急手术干预的密切协调。认识到下行性坏死性纵隔炎是一种可能由口咽感染引起的临床实体很重要，因为早期干预可显著降低随后的并发症和死亡率。此外，咽穿孔是一种极其罕见的并发症，诊断需要口服造影剂的CT或食管造影。
